Benace-5mg***

Class: Antihypertensive/ACE inhibitor Action Competitively inhibits angiotensin I-converting enzyme, resulting in the prevention of angiotensin I conversion to angiotensin II, a potent vasoconstrictor that stimulates aldosterone secretion. Results in decrease in sodium and fluid retention, decrease in blood pressure, and increase in diuresis. Indications Treatment of hypertension. Contraindications Hypersensitivity to ACE inhibitors. Route/Dosage ADULTS: Initial dose: PO 10 mg qd for patients not receiving a diuretic. In patients taking diuretics that cannot be discontinued, give initial dose of 5 mg. Maintenance: PO 20 to 40 mg/day as single dose or in 2 divided doses; doses up to 80 mg have been used. Interactions Allopurinol: Greater risk of hypersensitivity possible with coadministration. Antacids: May decrease bioavailability of benazepril; separate administration by 1 to 2 hr. Capsaicin: Cough may be exacerbated. Digoxin: Increased digoxin levels. Diuretics: May cause symptomatic hypotension after initial dose of benazepril. Indomethacin: May reduce effects of benazepril, especially in low-renin or volume-dependent hypertensive patients. Lithium: May increase lithium levels and symptoms of lithium toxicity. Phenothiazines: May increase effects of benazepril. Potassium preparations, potassium-sparing diuretics: May increase serum potassium levels. Lab Test Interferences None well documented. Adverse Reactions CV: Hypotension; ECG changes. CNS: Headache; dizziness; fatigue; hypertonia. DERM: Hypersensitivity reaction (eg, dermatitis, pruritus or rash with or without fever). GI: Nausea. HEPA: Elevated liver enzymes, elevated serum bilirubin. META: Hyperkalemia; hyponatremia; elevated uric acid; elevated blood glucose. RESP: Chronic dry cough. OTHER: Arthralgia; myalgia; angioedema; leukopenia; eosinophilia; proteinuria. Precautions Pregnancy: Category D (second and third trimester); Category C (first trimester). ACE inhibitors can cause injury or death to fetus if used during second or third trimester. When pregnancy is detected, discontinue ACE inhibitors as soon as possible. Lactation: Excreted in breast milk; avoid use in nursing mothers if possible. Children: Safety and efficacy not established. Angioedema: Use with extreme caution in patients with hereditary angioedema. Angioedema associated with laryngeal edema may be fatal. Hypotension/First-dose effect: Significant decreases in blood pressure may occur after first dose, especially in severely salt- or volume-depleted patients (eg, those undergoing dialysis or vigorous diuretic therapy), or those with heart failure. Risk is minimized by discontinuing use of diuretics, increasing salt intake » 1 wk before initiating benazepril or decreasing benazepril dose. Neutropenia/agranulocytosis: Has occurred with other ACE inhibitors. Renal impairment: Reduce dosage. PATIENT CARE CONSIDERATIONS Administration/Storage May be administered with or without food. Store in tightly closed container in a cool location. Assessment/Interventions Obtain patient history, including drug history and any known allergies. Note liver disease, CHF, concurrent use of diuretics, or dialysis. Ensure that kidney function tests and baseline electrolytes have been obtained prior to administration and monitor during therapy. Review baseline ECG. Assess BP and pulse before administration. If systolic BP is < 90 mm Hg, withhold medication and notify physician. Monitor for hyperkalemia in patients with impaired renal function, diabetes mellitus, and patients receiving potassium supplementation or potassium-sparing diuretics. Monitor closely for at least 2 hr after initial dose and during first 2 wk of therapy. If patient experiences sudden marked decrease in BP, withhold medication and notify physician. If sudden severe dyspnea, swelling of lips or eyes, or edema of hands and feet develop, withhold medication and notify physician. If BP is not controlled with bezapril alone, add a diuretic. OVERDOSAGE: SIGNS & SYMPTOMS Hypotension Patient/Family Education Instruct patient not to discontinue medication suddenly. Loss of BP control can result. Explain that exercise, salt restriction, and weight loss will enhance efficacy of medication and may allow for lowering of dosage. Tell patient that missed doses should be taken as soon as remembered but not to double up on doses. Explain that frequent follow-up appointments with physician are very important to adjust medication dosage. Teach patient how to monitor BP and instruct to check before taking drug. Warn patient not to take drug if systolic BP is < 90 mm Hg and to call physician. Advise patient to avoid intake of caffeine, salt substitutes, and foods high in potassium or sodium. Instruct patient to avoid sudden position changes to prevent orthostatic hypotension. Tell patient that medication causes dizziness and to avoid driving. Instruct patient to notify physician if chronic dry cough or other persistent symptoms occur. Explain that drug may cause impaired taste perception. Tell patient to notify physician if this symptom occurs. Tell patient not to take otc medications without notifying physician.